Shingles vaccine: Is our Fayette County Health Department unresponsive?

On May 25, 2006, the FDA approved a shingles vaccine known as Zostavax. Its maker, Merck and Co., has advertised it as recently as April 10 and 11 with full-page ads in the Atlanta newspaper.

Shingles, we are told, can be quite painful and hard to cure. People with relatives who have had shingles even hint at the possibility of becoming suicidal after contracting shingles, and after observing their loved ones’ pain they are generally the first ones to want to get vaccinated against shingles. Shingles generally affect older people who have had chickenpox in their youth, and that’s about 90% of people over age 60.

So now that the vaccine is available, what has our Fayette County Health Department done about it?

If Zostavax was easily available from physicians, I suppose it wouldn’t be important for our Health Department to get involved. But it turns out the vaccine is quite expensive and a lot of people are playing a little game with Zostavax.

We know in this country that when we turn 65 we get the health plan known as Medicare. Since early 2006 there has even been a Part D to Medicare that covers prescription drugs. Zostavax qualifies as a drug and is covered by Medicare prescription drug plans. The administration of the shot is reported to be covered by Medicare Part B, which pays for doctor services.

People on Medicare can get annual flu shots at no charge, and they can get them from the Fayette County Health Department. So why couldn’t they get the shingles vaccine there, a once in a lifetime vaccine, even if they have to pay a copay for the Zostavax itself?

Zostavax, it turns out, has a wholesale cost reported between $145 and $190 a vial. It’s hard to get quotes from doctors on getting the shot, but the cost seems to range from $218 to $279. For many people, that’s pretty expensive.

The companies that provide Medicare prescription drug insurance receive premiums for their coverage, and may over time save money from avoiding shingles claims prevented by the vaccine. So it’s not illogical for them to cover the Zostavax. But how do you get them to pay their portion of the cost?

One solution looks like this. You get a prescription for Zostavax, go to the drugstore, make your copay (around $50), pick up your vial of Zostavax, and then bring it to the doctor for your shot.

That doesn’t work. It seems the Zostavax comes in two vials, with one to be stored in a freezer and protected from light, and then when the frozen one thaws out the products are mixed and injected in the patient within 30 minutes. The product does not keep. It seems pharmacists don’t keep any in stock either, so this is impractical.

Even doctors aren’t too enthusiastic about storing expensive product like this in freezers. This is expensive inventory and the loss of a single vial through breakage or otherwise can be costly. But practically speaking, Zostavax is not a drug you get from a drugstore. You get it directly from your physician, who is not equipped to handle Medicare Part D claims and not prepared to go through the dual red tape of a Medicare drug claim and a Medicare medical services claim.

Meanwhile, Medicare patients interested in the vaccine are told to get the vaccine, paying up front whatever the cost is, and then file a claim for reimbursement from their Medicare prescription drug plan. These Medicare prescription drug plans, run by very large insurance companies long active in the healthcare field, aren’t very good at telling people what forms they need and how much money they’ll get back.

Everybody is pretty much passing the buck and not making it easy for anybody to get the vaccine at a reasonable cost.

Since our Fayette County Health Department is in the immunization business in a big way, and since it is a government agency dedicated to helping citizens with healthcare needs of that nature, I wonder why it is totally silent about this shingles vaccine. Why aren’t they addressing the issue and trying to help our local citizens?

Our county health department is not operating in a vacuum. Its personnel is in touch with state and federal officials charged with healthcare. If these government people wanted to, they could help make the shingles vaccine available to our older citizens in a practical, affordable way. The least our county officials could do would be to post information on their website about their progress in making the system work.

Your thoughtful comments on this situation are welcome.

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